Age mainly affects a woman’s fertility rather than men’s although there is some evidence that the quality of men’s sperm does reduce with age. When a woman is born they are born with a storage of oocytes (eggs) in their ovaries. As they become sexually mature and start to menstruate, each month 1 or 2 eggs are naturally released from the ovaries (once they are mature) for the purposes of reproduction – this is called ovulation. The peak reproductive age for women is between 19 and 25. Any couples in New Zealand are not in a position socially, financially or emotionally to be able to start a family at this time, therefore many choose to start a family in their late 20’s and during their 30’s. As a woman ages, so do the eggs stored in her ovaries. The body produces varying hormones at different times in a women’s cycle to assist in supporting pregnancy. Some of these hormones include Progresterone (P4), Oestrogen (E2), Luteinizing Hormone (LH), Follicle stimulating hormone (FSH) etc. Over time one of more of these hormones may not be produced at the appropriate levels to support the uterus lining from being of the right thickness to support pregnancy, healthy egg maturation, or even allow ovulation to take place in the first instance. All these factors play a role in impaired infertility. Ageing decreases a woman’s chances of having a baby in the following ways: The ability of a woman’s ovaries to release eggs ready for fertilization declines with age. The health of a woman’s eggs declines with age. As a woman ages she is more likely to have health problems that can interfere with fertility. As a woman ages, her risk of having a miscarriage increases.

If we are having problems conceiving, how long should we wait before seeking assistance?

A couple is regarded as infertile when they have not conceived after 12 months of regular unprotected sexual intercourse. If this is you and you are 35 years or under, you should seek the opinion of a Specialist in the field of Assisted Reproductive Technology. You are able to self refer to any clinic in New Zealand. Find a clinic new you by clicking here If you are a woman and are 35 or over you may wish to refer after 6 months of trying to conceive naturally. Other indicators for seeking referral would be diagnoses of problems such as PCOS, endometriosis, previous trauma to male reproductive organs or history of oncological treatment etc. Please contact your GP or contact us at Fertility NZ if you would like further advice.

Who should we go and see if we are having problems conceiving?

We strongly advise that you either ask your GP to be referred to the Fertility Clinic nearest to you or you are able to self refer to any clinic throughout New Zealand.

Does stress affect fertility?

There is plenty of evidence that fertility causes stress, but very little that stress causes infertility. Fertility treatment is recognised as one of the most stressful life situations. The loss of one’s fertility – the dream of a family – is akin to the loss by death of a loved one. The depression experienced by an infertile couple can linger for years and years. It is normal to feel stressed at times. It is important to take time out and continue to undertake activities that you and your partner enjoy. Exercise is a great stress reliever. Our Regional Contact People are more than happy to talk to you if you need a listening ear and likewise, the Counsellors at the Fertility Clinics would be equally happy to see you.

What happens during my first appointment with a Fertility Specialist?

The Specialist will ask you a number of questions about your general health, any past medical problems you have had. They will ask you some very private questions about your sexual health and your menstrual cycles as well. It is very important to disclose as much information as you can here. This will assist your Specialist to decide on the best course of action or treatment for you. Even though you may find it extremely embarrassing to talk about, please do disclose if you have any past history of a sexually transmitted disease. This may be a significant factor affecting your fertility and will help prevent you from undergoing unnecessary treatments and tests if this is known. i.e. it may be indicated to move straight to an IVF cycle before trying other less invasive options. Time can be of the essence. The Specialist will also perform a brief internal examination of the woman. It also helps to have some questions written down when you attend these appointments with a Fertility Specialist. This will help you make the most of your time with them.

What type of tests can I expect to undergo when being investigated for infertility?

If you are being referred by your GP or another Specialist to a Fertility Clinic, they may have already performed some basic blood tests and a semen analysis on you and your partner. The blood tests in the first instance will be taken on Day 3 of your cycle and another may be done on Day 21. These are to measure certain hormone levels e.g. Oestrogen, FSH (follicle stimulating hormone) levels, Progesterone Levels etc. You partner may also be required to re-submit a semen sample for further analysis at the Clinics Andrology Lab. Their measuring criteria is different to that from the mainstream labs and typically tests for a number of other things that other labs don’t. From your blood tests, it is also common for your Fertility Specialist to recommend you undergo a HSG (Hystosalpingogram) test. This is a procedure undertaken in a Radiology Department where contract liquid is induced through your ovaries and fallopian tubes to ensure there are no blockages or tubal damages. Although this procedure is reasonably straight forward, it can come with some significant discomfort during and afterwards. You will be asked to take some analgesia pre and post procedure. It is unlikely that you will be able to return to work after this test. If other problems are suspected such as endometriosis, adhesions (scar tissue), ovarian or endometrial cysts etc, the Specialist will recommend you undergo a Laparoscopy and may also choose to undergo a Hysteroscopy at the same time. Laparoscopy This is a procedure conducted under General Anaesthethic. Tubes will be placed through small incisions in your abdomen; one tube contains a camera and light at the end to help the surgeon manoeuvre and view your reproductive organs. Another allows for instruments to be introduced to perform surgery such as removing cysts, endometriosis removal of fibroids, adhesions (scar tissue) and the third pumps air into your abdomen so that the surgeon has plenty of room to work from. These days 99% of patients will undergo this surgery as a day case procedure. You will be discharged to go home on the same day you have the surgery. You may experience minor abdmominal discomfort for a few days and it is recommended that you take it easy and don’t lift heavy objects but the recovery for this is usually very good. Patients can often return to work within 1-2 days provided their work does not involve moderate to heavy labour. Hysteroscopy This operation is performed under a general anaesthetic. It is usually done for fertility investigation in conjunction with a Laparoscopy. When you are asleep the the cervix is gently stretched. This allows a telescope to be inserted into the uterus to give a good view of the lining of the uterus. It is also possible for the surgeon to take a sample of this lining. The sample will be send to the laboratory for analysis. This will be discussed with you before your operation. If you are having a hysteroscopy as part of your fertility investigations it is essential that you must not be having your period when the test is done. You may experience a small amount of spotting or minor vaginal bleeding after this procedure. This is normal.

I am confused, when do I count Day 1 of my cycle?

Day 1 of your cycle is the first day of bleeding if it starts before 12 pm. If bleeding starts after 12 pm, count Day 1 as the next day you wake up.

How can I tell when I am ovulating?

Ovulation for most women occurs anywhere between Day 10 to Day 17. Some woman with ovulation disorders will ovulate outside of these times or not at all. Many women report feeling some back ache, a little bit of discomfort around one side of their abdomen, cervical mucus may be of an egg white consistency. There are Ovulation Prediction Test kits (LH surge kits) available from Pharmacies. There are also other forms of ovulation predictor tests available such as saliva testing. The best and most assured way to measure ovulation is via blood testing. Often when undergoing fertility treatment you will be required to have a blood test from Day 10 of your cycle until the time you have ovulated. The Fertility Clinic nurses will advise you of when you are ovulating or when your LH surge is.

How many sperm do we actually need?

There is no single number, just a deceasing probability of getting pregnant with fewer sperm. The question is complicated, because often low sperm numbers and poor quality sperm go together – so it may not be the low number but rather the poor quality that is contributing to infertility. Poor quality is usually in relation to the shape or the way sperm move – most sperm have a correct genetic make-up, which is why ICSI can give good pregnancy rates and normal children despite often using ‘abnormal looking sperm.

What does fertility treatment cost?

The costs of fertility treatment is dependent on the treatment you undergo to try and achieve pregnancy and also to the individual clinic. Some people may have access to publicly funded treatment, however there may also be long waits to access this, therefore you may have to make the decision whether to go private.An IVF cycle may cost $8,000 - $15,000 with variables affecting the cost including the procedures required (such as ICSI) and appropriate drug protocol.

What are the criteria for publicly funded treatment?

Publicly funded treatment is available if you meet certain criteria based on what is termed as CPAC scoring. You will need to have a CPAC score of 65 or greater to enable you to be placed on the IVF waiting list for publicly funded treatment. Your score will be dependent on a number of things including: Medical diagnosis – each party Length of infertility diagnosis Previous ART treatment Women’s age – not currently available to women 40 and over FSH level Co-morbidities i.e. weight (under or over), smoker, previous drug use etc If you currently have children If you have had tubal ligation or vasectomy FertilityNZ work hard to lobby Government to extend the current access criteria, the amount of public funding for treatment and to ensure fair and equitable access for all consumers of ART. We are the only organisation in New Zealand who undertakes this work. This is why your support as a member by registering on this website is very useful. Numbers count towards our voice becoming louder when lobbying for these issues.

Can I still work while going through an IVF cycle?

Of course you can choose to take some extended leave whilst undergoing an IVF cycle, but provided you can readily access blood tests, attend scans, the pick-up and embryo transfer at the scheduled times, there is no reason why you cannot continue to work. You may experience some additional tiredness and lack of concentration during this time as a side effect from the drugs, however this should not impede your ability to conduct your work. If you are concerned, discuss this with one of the Nurses at your Clinic.

Side effects differ from person to person and are dependent on the drugs you have been prescribed and dosages. Typically because fertility drugs interact with your pituitary gland and therefore hormonal system some of the following symptoms are very common: Hot flushes Fatigue Tender breasts Abdominal bloating Emotional – e.g. mood swings, feeling low or sad, tearful Mind fog or brain freeze Lack of concentration Acne Nausea Many individuals feel very positive when they are on an IVF treatment cycle. There is a sense of hope and they feel like that are taking some sort of action to achieve the desired outcome, therefore this can counteract any negative side effects from the drugs.

Is it normal to feel anxious about fertility treatment?

YES. This is very normal, whether it be your first round of IVF or one of many IVF cycles. You will no doubt have a million thoughts going through your head… How am I going to make that blood test without the boss knowing what I am up to? What if I don’t get any follicles? What if I get pregnant? What if I don’t get pregnant? Can we afford more treatment? How are the drugs going to affect me? The list goes on. It’s the old adage – there is plenty of evidence to show that infertility creates stress but not that stress creates infertility. If you are experiencing significant anxiety attacks you may wish to access the Fertility Counsellor who will be able to advise in some strategies to manage this. It may also help you to talk to someone who understands. Feel free to contact our Regional Contact People.

Who should I tell?

This is an individual choice although most Fertility Counsellors will recommend you are very selective about who you share with. If you continue to have failed cycles, it will get harder and harder if people are continually asking if you have been successful. It may be that you feel very comfortable about being open with your friends and family, however please show respect for your partner and ensure they are happy for these details to be shared also. Some find it incredibly difficult to discuss their journey with others. Infertility is a very private issue and not easily understood by those that have not experienced this. FertiltyNZ can offer objective, empathetic and confidential support. If you would like to access one of our Regional support groups, talk to one of our Regional Contact People or access our Chatroom. It helps to know that you are not alone. Our Friends and Family page has some very good information and articles to help your loved ones understand what you are going through. You might like to point them in this direction.

I feel so sad and cry often – am I depressed?

It is very normal to feel sadness and grief during this process – often frequently. It is also important to try and acknowledge this in some way. There is a very high incidence of clinical depression for those experiencing infertility. After all you are experiencing repeated grief and loss (often month after month) so you are right to ask this question. Some things to consider are: Do you lack motivation? Do you have trouble sleeping? Are you tearful much of the time? Are you experiencing more relationship breakdowns than usual? Has your appetite changed? Have you stopped spending any time on personal activities – social, hobbies, sports Are you taking alcohol or drugs more than usual? Are most of your thoughts about yourself negative? Do your feel indecisive? Do you feel generally unhappy or insecure? If you think this describes your current emotions we would recommend you either discuss this issue with your GP or a Counsellor at the Fertility Clinic. It is okay to feel depressed considering what you are going through and it may be that simply by talking to someone may help you move through this. This is very normal and should not be viewed in a negative way. It is not okay to leave your feelings to continue to spiral downwards. This will also ultimately affect your ability to handle further fertility treatment effectively. There are people that can help. Please also contact your Regional Contact Person if you simply need to talk to an empathetic person or need a listening ear – we are here for you and nearly all of us have experienced a number of the above aspects at one stage or another during our own journeys.

How do you cope with the dreaded two week wait?

There are so many strategies for this. No matter what strategy you employ – this is one of the hardest times for anyone undergoing fertility treatment or even trying to conceive naturally. Some of the strategies of our members include: Plan some self indulgent activity in both Week 1 and Week 2 e.g. have a massage or a facial, have your hair done, go to the movies etc. Plan some time away after the result. This will be good whether it is either a positive or negative result. You need time to digest the positive result or time to grieve and regroup if it is a negative result. Keep active. Do not give up normal activities? The facts are that nearly everyone will do one or more of these activities during the two week wait. You will be tempted to poke your breasts to see if they are tender – this may be a symptom of the drugs – it may be a symptom of pregnancy. You will be hypersensitive to any abdominal feeling cramps – if the cup is half full you will put this down to possible pregnancy or if the cup is half empty possible period cramping. You will start to count how many times you go to the toilet – it may be a symptom of pregnancy or it may be that you didn’t realise before counting just how many times you go in a day! When you go to the toilet you may be looking for any signs of spotting – the spotting could mean implantation or it could be a sign of your period starting. You may start to think you are feeling nauseous. This may be true or it may be that you are simply worrying yourself sick. You may feel that your abdomen is bloating – is this your period or are you pregnant? As you will see by the above perceived or real symptoms you can be guaranteed to experience some of these thoughts and feelings. At the end of the day only a blood test or Pregnancy Test Kit will give you the answer. Don’t be tempted to test early as this may give you a false positive or false negative. The blood test is the only accurate way of testing. It is much easier to say this than do it, but do try and stay positive. The embryo you have on board is where mother nature intended it. If you have a negative result, nothing you have done will have caused that result so don’t be tempted to blame yourself.

I have been lucky enough to get pregnant but I don’t feel this is real. Is this normal?

YES! Those who achieve pregnancy through ART have often waited a very long time for this result, sometimes the reality that they are going to have a baby does not seem real. It may be that you have also experienced pregnancy loss previously so you may not want to get your hopes up. Many women who achieved pregnancy via fertility treatment find it hard to even start shopping for the baby even after they have been told their pregnancy is healthy and viable! There are many people that cannot bring themselves to set up until the last minute. This does not mean that you won’t bond with your baby when the time comes or won’t make a great parent.

I have been successful, now how can I help others?

Often people feel after they have been successful with fertility treatment that they would like to give something back to others in a similar situation. Dependent on the type of infertility you have there are a number of ways you may be able to help: Assist on an FNZ Regional Committee. We are always keen to hear from people willing to volunteer some time. You may like to become an egg donor. This is a particularly viable option if you are under 35 as you can then donate for someone on the public waiting list. You may already know someone who is in need of an egg donor, if this is so you may consider donating if you are over 35, however the age of eggs often have a bearing on the outcome. Embryo donation is now an option in New Zealand. Sperm donation. The Counsellors at the Fertility Clinic you attend can discuss these options with you and see if there is any viable way you can help another couple.